Escherichia coli enteritis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Serge Korjian M.D., Yazan Daaboul, M.D.

Overview

E. coli enteritis may be classified according to the E. coli species into Enterotoxigenic E. coli (ETEC), Enteropathogenic E. coli (EPEC), Enterohemorrhagic E. coli (EHEC), Enteroinvasive E. coli (EIEC), and Enteroaggressive E. coli (EAEC).

Classification

E. coli enteritis may be classified according to the involved E. coli species into the following:

• Enterotoxigenic E. coli - ETEC
• Enteropathogenic E. coli - EPEC (including diffusely adherent E. coli (DAEC), a subtype of EPEC)
• Enterohemorrhagic E. coli - EHEC (may be Shiga-like toxin producing (STEC) or Verotoxin-producing (VTEC))
• Enteroinvasive E. coli - EIEC
• Enteroaggressive E. coli - EAEC

The following table demonstrates the distinguishing clinical features and pathophysiological mechanisms of various enteritis-causing E. coli strains:

Properties/Symptoms	ETEC	EPEC	EHEC (STEC or VTEC)	EIEC
Toxin	LT/STa	-	Shiga or Vero toxin	-
Invasive	-	-	-	+
Intimin	-	+	+	-
Enterohemolysin	-	-	+	-
Stool	Watery	Watery, Bloody	Watery, very bloody	Mucoid, bloody
Fever	Low	+	-	+
Fecal leukocytes	-	-	-	+
Intestine involved	Small	Small	Colon	Colon, lower small
Serology	Various	O26, O111 & others	O157:H7, O26, O111 & others	Various
IDb	High	High	Low	High

^{a=LT, labile toxin; ST, stable toxin; b=ID, infective dose.
Adapted from Food and Drug Administration (FDA) - Bacteriological Analytical Manual Chapter 4A - Diarrheagenic Escherichia coli.}